Psych condensed Flashcards
What is an advanced directive?
Legally binding document - Made with capacity
Stipulates patients refusal of certain medical interventions
What is the court of protection?
Make decisions if no LPA
Resolves disputes if there is disagreement with treatment plans
What are DOLS?
Allows deprivation of liberty over someone who lacks capacity
Legal framework for hospital / care environment if it is in patient’s best interests
Name 5 principles of the mental health act
Maximize patient and public safety
Minimize the impact of mental illness on the patient
Minimize restriction of liberty
Use the least restrictive option
Effectiveness of proposed treatment
Describe section 2 of MHA
ASSESSMENT
Duration - 28 days
2 doctors - S12 and AMHP
Can be coercively treated
Describe section 3 of MHA
TREATMENT
Duration - 6m
2 doctors - S12 and AMHP
Describe section 4 of MHA
EMERGENCY
Duration - 72 hours
Proffesionals - 1 doctor and AMHP
Usually converted to S2
Describe a section 5(2)
DOCTOR order
Duration - 72hours
For patient already admitted
No coercieve treatment - just legal framework to restrain
Describe a Section 5(4)
NURSES order
Duration - 6 hours
Describe a section 135
Court order to enter house and move to place of safety for assessment
Proffesionals - ASW + medical professional + Polcie
Describe a section 136
Duration 24 hours
Arrest a person and bring to place of safety
Describe the key principles of MCA
Assume capacity
Least restrictive option to patients rights
Respect unwise decisions
Decisions must be in their best interests
Help must be given to aid in their capacity
what is an illusion
Misinterpretation of real external stimulus
what is a hallucination
Perception in absence of external stimulus
what is a delusion
false belief firmly maintained despite evidence of contrary
Out of keeping with patients social and cultural background
What is the MOA of antipsychotics
Block parasympathetic D2 receptors in mesolimbic pathway
What pathways are affected by excess dopamine in schizophrenia
Mesoimbic - Positive sx
Mesocortical - Negative sx
What pathways do antipsychotics target / have an effect on
Block D2 receptors - Mesolimbic
Hyperprolactniaemia - Tuberoinfundibular
EPSE - Nigrostriatal
When should antipsychotics be cautioned
Elderly - Stroke and VTE risk
Drugs prolonging QT - Amiodarone / Macrolides
What are the side effects of typical antipsychotics
EPSE Drowsy Hypotension QT Prolongation Erectile dysfunction Hyperprolactinameia
What are the side effects of atypical antipsychotics
Metabolic disturbance - Lipid changes / DM
Weight gain
Prolonged QT interval
Hyperprolactinameia - Sexual dysfunction
How long should you continue antipsychotics after an acute episode
5 years
Name 5 side effects of clozapine
Reduce seizure threshold Agranulocytosis constipation Hypersalivation Myocarditis
What affects clozapine levels
Smoking and alcohol - decreases levels
Name the order that EPSE appear
Acute dystonia
Akinthesia
Tardive dyskinesia
Parkinsonism
What is acute dystonia
Occurs after HOURS
Sustained msucle contraction - torticollis / oligouric crisis
How do you treat acute dystonia
Procyclidine
What is akinthesia
Develops after days to weeks
restlesness
tremor
What is the treatment of akinthesia
Propanolol
Cyproheptadine
What is tardive dyskinesia
> 6m usage
Repititive actions - grimacing / lip smacking / tongue protrusion
What is the treatment for tardive dyskinesia
Tetrabenzine - D2 agonsit
What is the treatment of Parkinsonism
Procyclidine
Name 8 side effects of SSRIs
Size - weight gain Sick - N+V Seizure - Reduce threshold Suicide Sodium - Hyponatramia Sexual dysfunction Sleep / stress Stomach upset - dyspepsia / Abdo pain
When should SSRIs be cautioned
PUD
Epilepsy
young patients
What drugs interact with SSRIs
MOA + Triptans –> S.S
NSAIDs/Aspirin –> Requires PPI
Antipsychotics –> QT prolongation
Describe SSRI withdrawl sx
Mood change Sleep issues Sweating Restlesness D+V
Howlong should SSRIs be continued for
6m
Name 2 SNRIs
Venelefaxine
Duloxetine
Name CI to venelafaxine
Raises BP - CI in cardiac disease
Name 5 side effects for TCA
Anticholinergic
- urinary retention
- blurred vision
- constipation
- confusion
Anti-adrenergic
- Postural hypotension
- Impitence
Describe a TCA overdose
Confusion Arrhythmias - QT prolongation seizures flushing dialted pupils vomiting
What would an ABG in a TCA overdose show
Metabolic acidosis
TCA overdose management
Supportive
Activated charcoal (2-4 hours)
IV bicarbonate
What should be avoided when taking MAOI
Cheese
Beer
red wine
smoked meat or fish
contain tyrmaine - vasoconstrictor
Treatemnt for hypertensive crisis in MAOI
Phentolamine
What affects Lithium levels
Dehydration and volume depletion
Thiazide diuretics
ACEi / NSAIDs - affect kidney fucntion
Theraputic side ffects to lithium
L - Leukocytosis I - Diabetes insipidus T - Fine tremor H - Hypperparathyroid I - Increased GI motility U - Underactive thyroid M - Ebsteins anomoly
Toxic lithium side effects
T - Coarse tremor O - Oliguria X - Ataxia I - Increased reflexes C - coma / convulsions
What are the effects of pscyhiatric medications in the elderly
Higher fat/water distribution - Reduced Benzo dose
reduced renal and heaptic functions
slower titration of meds
Describe serotonin syndrome
drugs
presentation
management
SSRIs / Triptans / MAOI / Ecstacy / Tramadol / St john wart
INCREASED ACTIVITY
- clonus / myoclonus
- Increased reflexes
- Rigidity
- tremor
- dialted pupils
- Autonomic sx (Tachy /unstable BP / Hyperthermia)
IV fluids
BDZs
Cryproheptadine - serotonin antagonist
Desribe NMS
Antipsychtoics / Withdrawl of dopaminergic drugs
Lead pipe rigidity
normal pupils
Hyporeflexia
Autonomic sx (Tachy / sweating / unstable BP / hyperthermia)
Stop antipsychotics
IV fluids
Bromocriptine / Dantrolene
What metabolic presentation is present in NMS and SS
Metabolic acidosis
What would FBC shouw in NMS
Leukocytosis
Why is it important to check U+E in NMS
Increased CK –> AKI
Rhabdomyolysis
How many features and for how long are required for it to be classified as a dependence disorder
3 features for > 1 month
Name 5 features of dependence
continued use despite harm salience narrowed repitoire withdrawal cravings tolerance loss of control rapid reinstatement
How do metronidazole and alcohol interact
Metronidazole inhibits acetaldehyde dehydrogenase leading to build up of acetaldehyde
Drinking –> N+V / Headache / Sweating
Alcohol units calcualtion
% x volume (ml) divided by 1000
Psychological management of addictive behaviours
1 - Maintenence or withdrawal
2 - Motivational interviewing / AA / FRAMES
Name 3 drugs used in alcohol withdrawal
Disulfram
Acamprosate
Naltrexone
MOA of disulfram
Inhibits acetaldehyde dehydrogenase - S/E if alcohol ingested
flushing
headache
reduced BP
Nausea
MOA of acamprosate
Reduces craving by inhibiting glutamate
MOA of naltrexone
Opiod antagonist - reduces pleasure alcohol brings
Alcohol withdrawl - sx 6/12 hours post
Tremor sweating N+V Anxiety Tachycardia
Alcohol withdrawl - 12-24 hours post
Hallucinations
Alcohol withdrawl - 36 hours post
Seziures
Alcohol withdrawl - 72 hours post
DELIRIUM TREMENS
Altered consciousness
Persucotary delusions
coarse tremor
Tachycardia
sweating
Increased BP
Fever
Halluciantions - Lilluptian / formication
What is the management of delirium tremens
Chlorodiazepioxide
Thiamine
Pabrinex
Describe opiate intoxication
drowsy reduced resp rate Pinpoint pupils Decreased BP Decreased HR
Describe opiate withdrawl
EVERYTHING RUNS
Rhinorrhoea Lacrimation Pupil dialtion Sweating Diarrhoea N+V Agitation Abdominal cramps
Describe opiate withdrawl management
Lafexidine
BDZs - agitation
Antimetics
Describe opiate overdose
Pinpoint pupils coma resp depression seziures Hypothermia
Describe opiate overdose managemnt
IV/IM Naloxone - short half life
O2
IV hydration
What drugs can be used for substance abuse dependence
Methadone - logn acting
Buprenorphine - Partial agonsit
Naltrexone - for patients completing detox
substance abuse Short term complications
VTE
PE
Infection - IE
Respiratory depresion - acidosis
Describe BDZs overdose
anxiety insominia tremor agitation headache seizures
Describe cannabis intoxication
drowsy imapired memory slow reflexes bloodshot eyes increased appetite
causes of delirium
D - Drugs (Anticholinergic/ BDZs/Anticonvulsant E - Electrolyte L - Lack of drug (opiates /levodopa/alcohol) I - Infective R - Retention / reduced sensory I - Intracranial (stroke / post ictal) U - Underhydration/nutrition M - Myocardial
RF for Alzehimers disease
FHx Downs syndrome Apolipoprotein E4 Depression Female Age
Alzheimers sx
Amnesia Aphasia Agnosia Apraxia Apathy Depression
Alzehimers Mx
Acetylcholinesterase inhibitors - Rivistagmine / Donepezil
NDMA receptor antagonist - Memantine
Alzehimers Mx
Acetylcholinesterase inhibitors - Rivistagmine / Donepezil
NDMA receptor antagonist - Memantine
Adverse effects of ACh inhibitors
Headache / Diarrhoea / Bradycardia
Adverse effects of memnatine
confusion hallucination dizzy seizure constipation
GAD management
1 - Education and active mointioring
manage co-morbidities
exercise
sleep hygiene
2 - Low intensity psychological
Guided self help
Psychoeducation
3 - High intensity intervention
CBT/Applied relaxation +/- SSRI
4 - CBT + SSRI
Panic disorder presentation
Sx peak within 10 mins
P – Palpitations A – Abdominal distress N – Numbness/nausea I – Intense fear of death C – Choking/chest pain S – Sweating/shaking/SOB D – depersonalization/derealization
Describe the characteristics of the obsessions in OCD
Intrusive
Recognised as patients own thoughts
Non sensical - unlide delusions
Management of OCD
1 - Low intensity CBT / ERP
2 - High intensty CBT / ERP OR SSRI
3 - High intensity CBT/ERP + SSRI / TCA
How long should you continue medication for in OCD
12 months
What are the requirements for PTSD diagnosis
Sx arise within 6m of event
Sx present for > 1 month with functional impairment
Describe PTSD presentation
Hyperarousal - startle / seep issues
Flashbacks
Avoidance
Emotional numbing
PTSD management
1 - Trauma focused CBT / EMDR
2 - Sertraline / Venelfaxine
PTSD management
1 - Trauma focused CBT / EMDR
2 - Sertraline / Venelfaxine
What are the componenets of the SCOFF questionnaire
S - Sick C - control O - one stone (3m) F - Fat F - Food domiantes
Name 6 features of anorexia
Arrhythmias - QT prolongation Lanugo hair yellow tinge to skin constipation swelling of parotid and submandibular glands
Features of hypokalaemia
Flat t waves T wave inversion U waves ST depression Arrhythmias - VT
Biochemical features of anorexia
Increased G + C
- GH
- Cortisol
- Beta carotene
- Cholesterol
Anorexia red flags
BMI < 13.5Kg
>1kg/week weight loss
Temp < 34.5
Proximal muscle weakness
Anorexia management - Adult
1 - CBT - ED
2 - MANTRA
What does MANTRA stand for
Maudsley Model of Anorexia Nervosa Treatment for Adults
Anorexia management - Child
1 - Family focused therapy
2- CBT
Anorexia complications
Osteoperosis
cardiac atrophy
Long term anorexia management
DEXA scan
Refeeding syndrome presentation
Oedema tachycardia confused CCF Blaoting
What metabolic disturbances occur in bulimia
Laxatives - acidosis
Purging - alkalosis
What complication occurs with long term laxative use in bulimia
Cardiomyopathy
bulimia management
1 - BN focused guided self help
4 weeks
2 - CBT - ED
Criteria for depression diangosis
5/9 sx
D - Depressed mood
E - Energy low
A - Anhedonia
D - Dead thoughts
S - Sleep W - Worthlesness A - Apetite / weight M - Mentation decreased P - Psychomotor retardation
DDx of depression
Parkinsons dementia Hypothyroid Hypoadrenalism Steroids Alcohol DM
Features of mania
Sx present for 7 days
marked fucntional impairment
Psychotic sx
- delusions of grandeur
- Auditory hallucinations
